session 1 mo healthnet division (mhd) provider resources · 21_2014feb03.pdf. 6 ... email:...

Session 1

MO HealthNet Division (MHD)

Provider Resources

Gina Overmann and Kim Morgan

Provider Education Representatives

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• MHD policy updates

• Resources available to providers

• Navigating Provider Participation webpage

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Frequently Asked Topics

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Provider Bulletin Webpage: http://dss.mo.gov/mhd/providers/pages/bulletins.htm.

Hot Tips Webpage: http://dss.mo.gov/mhd/providers/pages/provtips.htm.

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Effective for DOS September 12, 2014: o CPT code 90688 SL (state supplied) o MHD reimburses $5.00

Effective for DOS August 31, 2014: o CPT code 90655 SL Influenza virus vaccine o Non-Covered

Provider Bulletin http://dss.mo.gov/mhd/providers/pdf/bulletin36-

21_2014feb03.pdf.

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Providers must enroll in VFC program,

if giving immunizations to children under age 18

Use free vaccine from Department of Health and Senior

Services (DHSS)

Provider based Rural Health Clinics (RHCs) and

Federally Qualified Health Centers (FQHCs) may not

bill separately for administration of injections

~ Include in cost report

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Covered VFC administration codes

SL (state supplied) modifier located in

Local Public Health Department Billing Book:

http://dss.mo.gov/mhd/providers/education/health/

Section 6:

http://dss.mo.gov/mhd/providers/education/health/health06.pdf

MHD covers vaccine administration codes for non-VFC vaccines

◦ 90460 (first/only component)

◦ 90461 (each additional component)

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Medicaid Eligibility (ME) codes 80 & 89

◦ Limited benefit program – family planning services

◦ Primary diagnosis code V25-V25.9

Provider Manuals, Section 10 – Family Planning

http://manuals.momed.com/manuals/.

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ME plan codes 80 and 89

ME 80 - Uninsured women, who lost MHD

eligibility 60 days after birth of a child, up to 1

year

ME 89 - Expanded program for uninsured women

Not eligible after sterilization or hysterectomy

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Family planning counseling, education, and birth control

Department of Health and Human Services approved methods of

contraception

Diagnosis, testing, including Pap and pelvic exams and treatment

of sexually transmitted disease found during a family planning visit

Drugs, supplies, or devices related to women’s health services -

prescribed by physician or advanced practice nurse

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Family planning services must be billed with primary

diagnosis code of family planning, V25-V25.9

If visit unrelated to family planning, visit and any

treatment or testing is not covered

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TEMP ME codes 58 and 59 – presumptive eligibility

for women who are pregnant

Limited to ambulatory prenatal care

Pregnancy or prenatal diagnosis code required

Inpatient hospital services are not ambulatory

prenatal services

Refer to Hospital Manual Section 13.3

http://manuals.momed.com/collections/collection_hsp/print.

pdf

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TEMP eligibility through end of month

following month made eligible

Required diagnosis must be pregnancy

related

V22.0-V23.9, V28.0-V28.9

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Children and youth under age 21

V20.2 diagnosis code for HCY screening, well child visit

All components for Full Screen, or bill Partial Screen

MHD screening guides, signed by screener, keep copy in

participant’s record

Electronic versions, if same data as MHD screening

guides

Complete Lead Risk Assessment electronically using

CyberAccess

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• Full screen – age appropriate preventive medicine CPT codes

and the EP modifier

• Partial screen – age appropriate preventive medicine CPT

code with both the EP and 52 modifiers

• Interperiodic screen – age appropriate preventive medicine

CPT code and NO modifier

Lists of these CPT codes are found in Physician Manual,

Section 9: http://manuals.momed.com/manuals/

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Wipro Help Desk, (573) 635-3559

Email: internethelpdesk@momed.com

Technical support and assistance for issues with

emomed.com

Establish required electronic claims and RA formats,

network communication, HIPAA trading partner

agreements

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Providers Initial Contact!

Contact with inquiries, concerns or questions regarding proper

claim filing, claims resolution and disposition, and participant

eligibility questions and verification.

Provider Communications Unit

PO Box 5500

Jefferson City, MO 65102-2500

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Provider Education (573) 751-6683 or

Email: MHD.provtrain@dss.mo.gov

Inquiries regarding education, training assistance and scheduling

Register for Training Today!

http://dss.mo.gov/mhd/providers/education/.

Pharmacy & Clinical Services (573) 751-6963 or

Email: clinical.services@dss.mo.gov

Policy development, benefit design, coverage decisions, provider and program policy inquiries

Pharmacy & Medical Pre-Certification Help Desk 800-392-8030

Pharmacy clinical authorizations, edit overrides, medical pre-certifications (outpatient, diagnostic, non-emergency MRI, MRA, CT, CTA, PET scans and cardiac imaging) pre-certification for certain radiological procedures listed at: http://www.medsolutions.com/implementation/mo_health/index.html

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MHD Services & Programs

Email: Ask.MHD@dss.mo.gov

Inquiries regarding programs and policies that cannot be

answered by any other contact information. Please

provide NPI, name and contact information, and

complete details regarding inquiry.

Account setup or technical questions?

Contact:

(888) 581-9797 or (573) 632-9797

Email: cyberaccesshelpdesk@xerox.com

CyberAccess web address:

www.cyberaccessonline.net. CyberAccess helpful Tips:

http://dss.mo.gov/cd/info/forms/reference/cyberaccess-helpful-

tips.pdf.

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Obtain MHD paid claim data - procedures, diagnosis codes,

and prescriptions

Request pre-certification for services: Radiology, Durable

Medical Equipment (DME), Optical services and Inpatient

Request Drug Prior Authorization (PA), or Clinical Edit

Override (EO)

Register for CyberAccess by contacting Xerox Care and

Quality Solutions help desk

To obtain pre-certifications, PA’s or EO’s, call (800) 392-8030,

or use CyberAccess

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Conducts investigations into allegations of fraud, waste

and abuse by providers and participants

PO Box 6500

Jefferson City, MO 65102-6500

Telephone: 573/751-3399

http://mmac.mo.gov/

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Located within MMAC Division

Inquiries regarding enrollment applications, changes to Provider Master File (addresses, tax identification, ownership, individual's name, practice name, National Provider Identification (NPI) number)

Email: mmac.providerenrollment@dss.mo.gov

Send written inquiries to:

Missouri Medicaid Audit and Compliance Unit P. O. Box 6500 Jefferson City, Missouri 65102

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Audio-Visual

Training

PowerPoint slide

presentations for various

programs and issues

May use as refresher,

quick reference, new staff

training, etc.

Print off or refer to as

needed

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The

Matrix

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• Located at Provider Participant Page, Section General

Information

• Quick reference for a list Category of Services by Medical

Eligibility (ME) codes to determine if a service is covered by

MHD

• Shows co-pays and key panel notes for additional restrictions

• Refer to Hot Tip for details of contact information

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Program Updates – Subscribe to MHD News

Hot Tips, Bulletins, Program Manual updates

Provider Participation webpage – One stop shop

Provider resources

http://dss.mo.gov/mhd/providers/index.htm

Provider Communications – First line of contact for claim

issues, denials

573-751-2896 or email from eMOMED

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